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The Effect of Bariatric Surgery upon Diabetes Mellitus: A Proof of Concept by Using the Case of the Mid-Term Effect of Lap Adjustable Gastric Banding (LAGB) on Patients with Diabetes. Metabolites 2022; 12:metabo12121236. [PMID: 36557274 PMCID: PMC9781846 DOI: 10.3390/metabo12121236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity is a worldwide epidemic, with numbers on the rise in the world. Obesity is strongly correlated with increased morbidity and mortality. One of the major factors affecting this increase is comorbid diseases such as diabetes mellitus (DM), which is strongly associated with and dependent on the degree of obesity. Thus, it is not surprising that when efficient surgical treatments were found to battle obesity, researchers soon found them to be relevant and effective for battling DM as well. Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgical treatment for morbid obesity. LAGB has the potential to improve control of the comorbidities of morbid obesity, primarily diabetes mellitus (DM). Our hypothesis was that patients treated with LAGB would have a long-term improvement in the control of DM and that due to its unique mechanism of action, this can lend us a better understanding of how to battle diabetes in an efficient and effective way. This was a cohort study based on patients who underwent LAGB surgery in our institution 4 to 7 years previously and had DM type 2 at the time of surgery. Data were collected from patient’s charts and a telephone interview-based questionnaire including demographics, health status, and quality-of-life assessment (Bariatric Analysis and Reporting Outcome System [BAROS]). Seventy patients participated in the current study. The average follow-up time was 5.1 ± 0.9 years post-surgery. The average weight prior to surgery was 122.0 ± 20.2 kg, and on the day of the interview it was 87.0 ± 17.6 kg (p < 0.001). The average body mass index before surgery was 43.8 ± 5.1, and on the day of the interview it was 31.2 ± 4.8 (p < 0.001). On the day of the interview, 47.1% of the participants were cured of DM (not receiving treatment, whether dietary or pharmacologic). The sum of ranks for diabetes was lower after the surgery (p < 0.001), as was HTN and its treatment (p < 0.001). We have shown in this study that LAGB is an effective treatment for morbid obesity, as well as two comorbidities that come with it—DM type 2 and Hypertension (HTN)—in a longer period than previously shown, and with a unique look at the underlying mechanism of action of this procedure. There is a need for further studies to consolidate our findings and characterize which patients are more prone to enjoy these remarkable surgical benefits.
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Guzel K, Ikizek M. Comparison of preoperative and postoperative Lipid Profile changes in obese and morbidly obese patients after mini gastric bypass surgery. Pak J Med Sci 2021; 37:1826-1831. [PMID: 34912402 PMCID: PMC8613039 DOI: 10.12669/pjms.37.7.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/25/2021] [Accepted: 06/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background & Objective: Obesity has become a serious health problem that has become increasingly important in recent years. Since patients with high levels of obesity have dyslipidemia and an unbalanced lipid profile, they have a high risk of both diabetes mellitus and cardiovascular disease. This study aimed to evaluate the short (3 months) and long term (12 months) effects of mini-gastric bypass surgery from the current bariatric surgical techniques on the lipid profile. Methods: Of the patients undergoing Mini-gastric bypass operation between January 2016 to December 2018 at the General Surgery Clinic of Private Samsun Büyük Anadolu Hospital, demographic data and changes in lipid concentrations at 3 and 12 months were analyzed. Patients were grouped according to age, sex, body mass index (BMI), cardiologic risk groups, bypass lengths, and obesity classes. Total cholesterol, triglyceride, LDL-cholesterol, and HDL cholesterol values of the patients were examined at the time of admission to the outpatient clinic before the operation, at the postoperative third month and at the post-operative twelfth-month. Patients who did not go for a checkup during the one-year follow-up and whose data could not be reached or missing were excluded from the study. Results: There was no significant difference in terms of age, sex, and cardiovascular risk (p> 0.05). Although the HDL-C level was initially low (p <0.001), it significantly increased 12 months after surgical treatment (p <0.001). While serum concentrations of LDL cholesterol, total cholesterol, and triglycerides were high preoperatively, they significantly decreased at 12 months postoperatively (p <0.001). When compared with values in the 3rd- and 12th-month, there was a significant decrease in the class-3 obesity group but not in the class-2 obesity group. When serum HDL cholesterol concentrations were compared with preoperative baseline and postoperative 12th-month those, no statistically-significant difference was found in serum concentrations in the 3rd month, although there was a significant increase in both class 2 and 3 obesity groups. Conclusion: In patients undergoing mini-gastric bypass surgery, serum LDL cholesterol, total cholesterol, and triglyceride concentrations decreased in the 12th postoperative month, but serum HDL cholesterol concentrations increased.
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Affiliation(s)
- Kerim Guzel
- Dr. Kerim Guzel, Assistant Professor, Department of General Surgery, Biruni University Faculty of Medicine, 34010 Topkapı, Istanbul, Turkey
| | - Mustafa Ikizek
- Mustafa Ikizek, Internal Medicine Clinic, Ankara, Turkey
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Ahmed S, Pouwels S, Parmar C, Kassir R, de Luca M, Graham Y, Mahawar K. Outcomes of Bariatric Surgery in Patients with Liver Cirrhosis: a Systematic Review. Obes Surg 2021; 31:2255-2267. [PMID: 33595790 DOI: 10.1007/s11695-021-05289-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
Obesity is commonly associated with non-alcoholic fatty liver disease and is a significant cause of chronic liver disease and cirrhosis. Some patients undergoing bariatric surgery suffer from cirrhosis of the liver. Currently, there is a lack of consensus on the management of these patients and the safety and efficacy of bariatric surgery in this group. This review aims to update our previously published systematic review on the same topic. A total of 21 studies reporting experience on patients with cirrhosis undergoing bariatric surgery were included. Sleeve gastrectomy was the most common surgery performed, followed by Roux-en-Y gastric bypass. The results show that bariatric surgery may be feasible in carefully selected patients with obesity and cirrhosis although they have slightly higher morbidity and mortality rates.
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Affiliation(s)
- Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Chetan Parmar
- Department of Surgery, University College London Hospital NHS Foundation Trust, London, UK.,Department of Surgery, Whittington Hospital NHS Trust, London, UK
| | - Radwan Kassir
- CHU Félix Guyon, Allée des Topazes, Saint-Denis, France
| | - Maurizio de Luca
- Department of Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
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Billy H, Surve A, Fairley R, Cottam D, Cottam A, Zaveri H, Cottam S. Weight Loss Outcomes of Laparoscopic Adjustable Gastric Band with Plication: a Single Center Experience of 66 Patients with 18-Month Follow-Up. Obes Surg 2018; 29:246-251. [PMID: 30251092 DOI: 10.1007/s11695-018-3512-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric band with plication (LAGBP) is a novel bariatric procedure, which combines the adjustability of the laparoscopic adjustable gastric band (LAGB) with the restrictive nature of the vertical sleeve gastrectomy (VSG). The addition of plication of the stomach to LAGB should provide better appetite control, more effective weight loss, and greater weight loss potential. The purpose of the study was to analyze the outcomes of LAGBP at 18 months. METHODS Data from all patients who underwent a primary LAGBP procedure from December 2011 through June 2016 were retrospectively analyzed. Data collected from each patient included age, gender, weight, body mass index (BMI), and excess weight loss (EWL). RESULTS Sixty-six patients underwent LAGBP. The mean age and BMI were 44.6 ± 12.7 years and 42.1 ± 5.1 kg/m2, respectively. The patients lost an average of 49% and 46.8% EWL at 12 months (77.2% follow-up) and 18 months (66.1% follow-up), respectively. The mean band adjustments were 2.1 ± 1.7 (range, 0-7) per patient in 1 year. The mean additional adjustment volume (infusion and withdrawal of saline) was 0.6 ± 1 cc. Dysphagia was the most common long-term complication. The band removal rate was 7.5%. The mortality rate was 0%. CONCLUSIONS LAGBP is a relatively safe and effective bariatric procedure. In light of recent studies demonstrating poor outcomes following LAGB, LAGBP may prove to be the future for patients desiring a bariatric procedure without resection of the stomach.
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Affiliation(s)
- Helmuth Billy
- Ventura Advanced Surgical Associates, 3200 Telegraph Rd, Ventura, CA, 93003, USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Ryan Fairley
- Ventura Advanced Surgical Associates, 3200 Telegraph Rd, Ventura, CA, 93003, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Surve A, Zaveri H, Cottam D, Cottam A, Cottam S, Belnap L, Medlin W, Richards C. Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up. Surg Obes Relat Dis 2018; 14:1139-1148. [DOI: 10.1016/j.soard.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
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The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 2017; 31:4331-4345. [PMID: 28378086 DOI: 10.1007/s00464-017-5505-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. METHODS An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. RESULTS Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. CONCLUSIONS These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.
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Hancock J, Jackson S, Johnson AB. Under and over 50: exploring long-term weight-loss outcomes following laparoscopic adjustable gastric band by age and body mass index group. Surg Obes Relat Dis 2016; 12:1616-1621. [PMID: 27567036 DOI: 10.1016/j.soard.2016.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB) surgery is used to enable individuals to lose weight. However, the long-term weight loss outcomes for individuals with a body mass index (BMI)≥50 kg/m2 and/or age≥50 years at time of banding remains debated. To date, data reported is largely from populations outside the United Kingdom. OBJECTIVES To explore long-term weight loss outcomes based on individuals' pre-LAGB age and BMI. SETTING Data were collected from individuals in the United Kingdom attending a national health service weight loss surgery service. METHOD Data pertaining to weight were collected in a prospective 5-year study in the United Kingdom. Individuals were grouped according to preoperative age and BMI before analysis. RESULTS Data from 53 individuals were analyzed. Individuals age≤49 years weighed 142.7±17.4 kg preoperatively, whereas individuals age≥50 years weighed 137.6±19.4 kg. Over the 5 years post-LAGB, significant weight loss was achieved by the whole sample. Additionally, there was an interaction between weight loss and age/BMI group. The sample had a significant percent total weight loss and percent excess weight loss between 6 months and 5 years post-LAGB. However, only individuals age≥50 years with a BMI≥50 kg/m2 preoperatively had continual weight loss over the 5 years. CONCLUSION Individuals lost weight following LAGB; however, only individuals with a BMI≥50 kg/m2 and age≥50 years before banding appeared to continue to lose weight as time since banding increased, compared with the other groups.
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Affiliation(s)
- Jude Hancock
- Independent Health Psychologist, Chippenham, United Kingdom; North Bristol NHS Trust, Bristol, United Kingdom.
| | - Sue Jackson
- University of the West of England, Bristol, United Kingdom
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Papadimitriou G, Vardas K, Alfaras K, Alfaras P. Laparoscopic adjustable gastric band: 4-year experience and learning curve. JSLS 2016; 19:e2013.00363. [PMID: 25848174 PMCID: PMC4370035 DOI: 10.4293/jsls.2013.00363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Laparoscopic adjustable gastric banding has become the most popular procedure for the treatment of morbid obesity in Europe. The objectives of this series are to report the results of the 4-year experience of a single surgeon and to define the learning curve. Methods: A retrospective review of 156 patients who underwent laparoscopic adjustable gastric banding between October 2006 and May 2010 was performed. Patients were separated into 3 groups: group 1 comprised the first 50 patients; group 2 comprised the second 50 patients; and group 3 comprised the last group of patients, with a total of 56 patients. Results: The male-to-female ratio was 1:4 (33 male and 133 female patients). The mean age was 38 years (range, 17–62 years). The mean preoperative body mass index was 44.9 kg/m2. The mean percent excess weight loss was 41.7% at the 1-year follow-up visit (153 patients, 98%), 49.7% at the 2-year follow-up visit (147 patients, 94%), and 50.2% at the 3-year follow-up visit (127 patients, 81%). The overall complication rate and major complication rate were 15.4% and 3.2%, respectively. There were no deaths. Percent excess weight loss, length of hospitalization (in days), and complication rates were compared among the 3 groups. No significant differences were noted among the groups except in the number of complications (P < .001), but all data were clearly improved in groups 2 and 3. Conclusions: The analyses in this study have documented one more time that laparoscopic adjustable gastric banding is an effective procedure for the treatment of morbid obesity, achieving >50% excess weight loss at 3 years. It is a procedure with certain complications even when performed by a surgeon with previous experience in laparoscopic surgery. According to our subset analysis, the learning curve is at least 50 procedures.
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Affiliation(s)
- Georgios Papadimitriou
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Konstantinos Vardas
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Konstantinos Alfaras
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Panagiotis Alfaras
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
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Zampieri N, Castellani R, Francia L. Is There Still a Role for Video-Assisted Laparoscopic Gastric Banding in Severe Obesity? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicola Zampieri
- Department of Surgery, University of Verona, AOUI, Verona, Italy
| | - Roberto Castellani
- Department of Surgery, Casa di Cura San Francesco Hospital, Verona, Italy
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Corcelles R, Daigle CR, Schauer PR. MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery. Eur J Endocrinol 2016; 174:R19-28. [PMID: 26340972 DOI: 10.1530/eje-15-0533] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.
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Affiliation(s)
- Ricard Corcelles
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Christopher R Daigle
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Philip R Schauer
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
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Caceres BA, Moskowitz D, O'Connell T. A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002-2013. J Am Assoc Nurse Pract 2015; 27:403-10. [PMID: 25736716 DOI: 10.1002/2327-6924.12235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/24/2014] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults. DATA SOURCES This review included 15 studies published between 2002 and 2013. CONCLUSIONS Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive. IMPLICATIONS FOR PRACTICE The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.
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Affiliation(s)
- Billy A Caceres
- New York University College of Nursing, New York, New York.,New York University Langone Medical Center, New York, New York
| | - Dana Moskowitz
- New York University Langone Medical Center, New York, New York
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12
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A retrospective comparison of early results of conversion of failed gastric banding to sleeve gastrectomy or gastric bypass. Surg Obes Relat Dis 2015; 11:379-84. [DOI: 10.1016/j.soard.2014.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/26/2014] [Accepted: 07/14/2014] [Indexed: 01/28/2023]
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13
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Lee WJ, Lee KT, Ser KH, Chen JC, Tsou JJ, Lee YC. Laparoscopic adjustable gastric banding (LAGB) with gastric plication: Short-term results and comparison with LAGB alone and sleeve gastrectomy. Surg Obes Relat Dis 2015; 11:125-30. [DOI: 10.1016/j.soard.2014.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 03/31/2014] [Accepted: 05/27/2014] [Indexed: 01/06/2023]
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Pedroso FE, Gander J, Oh PS, Zitsman JL. Laparoscopic vertical sleeve gastrectomy significantly improves short term weight loss as compared to laparoscopic adjustable gastric band placement in morbidly obese adolescent patients. J Pediatr Surg 2015; 50:115-22. [PMID: 25598106 DOI: 10.1016/j.jpedsurg.2014.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery has shown to be an effective weight loss treatment in morbidly obese adolescents. We compared outcomes of laparoscopic adjustable gastric band (LAGB) to laparoscopic vertical sleeve gastrectomy (VSG). METHODS A single institution, retrospective evaluation of a prospectively collected database of LAGB and VSG patients. RESULTS 174 morbidly obese patients underwent bariatric surgery at our institution between 2006 and 2013. 137 patients underwent LAGB and 37 underwent VSG. There were no significant differences between LAGB vs. VSG groups on day of surgery for age, gender, ethnicity, weight, and BMI. At 24-month follow up, patients who underwent VSG vs. LAGB displayed significantly greater percent excess weight loss (70.9±20.7 vs. 35.5±28.6, P=0.004) and percent preoperative BMI loss (32.3±11.0 vs. 16.4±12.7, P=0.004). Both VSG and LAGB significantly improved levels of HDL, HgA1c, and fasting glucose. LAGB patients had more complications than VSG patients. CONCLUSION Bariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. VSG results in greater short term weight and BMI loss when compared to LAGB. Longer follow up with more patients will be required to confirm the long term safety and efficacy of VSG in adolescent patients.
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Affiliation(s)
- Felipe E Pedroso
- New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, Department of General Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery
| | - Jeffery Gander
- New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, Department of General Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery; University of Virginia Health System, Department of Surgery, Division of Pediatric Surgery
| | - Pilyung Stephen Oh
- New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, Department of General Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery
| | - Jeffrey L Zitsman
- New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, Department of General Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery.
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Intermittent gastric prolapse after adjustable gastric banding is a potential cause of band intolerance: clinical and diagnostic findings from eight patients. Obes Surg 2014; 25:360-5. [PMID: 25487832 DOI: 10.1007/s11695-014-1515-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gastric banding surgery can fail if the patient develops frequent vomiting, intolerance of common food types or reflux. These patients can be divided into those with a well-defined anatomical problem such as slippage and those without. Intermittent gastric prolapse (IGP) is a possible explanation for some patients who do not achieve adequate early satiety without excessive food intolerance but have normal imaging. METHODS A series of eight patients was identified over a 2-year period with findings consistent with IGP. Cases were identified in the process of normal clinical practice and details reviewed retrospectively. Specific diagnostic methods included measures to increase pouch pressure above the band by either stress barium or endoscopy with pressure challenge. RESULTS The median time until diagnosis of IGP was 48.0 months (16-124), and weight loss over that time was 26.4 kg, or 69.6 % excess weight loss (EWL) (5.8-101.8). This fell to 43.7 % EWL after IGP was diagnosed and managed. The mean fill volume when the patients experienced IGP was 6.8 ml (4.5-9.0). Most patients were diagnosed by radiological investigation. Four patients underwent revisional surgery with the remainder treated conservatively. CONCLUSIONS Intermittent gastric prolapse may explain excessive food and fluid intolerance in gastric band patients who have normal initial imaging. These patients typically experience gross food intolerance with a relatively small increment in fluid volume with relief when the increment is removed. The diagnosis is best made with either modified stress barium or endoscopy with pressure challenge. Management entails establishment of a safe fill volume, modification of weight loss expectations and earlier discussion of revisional surgery.
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Abstract
In the past decade, bariatric surgery has garnered attention as a treatment for obesity in older adults. Its increased popularity is a direct response to growing obesity rates in this segment of the population. Bariatric surgery among older adults has emerged as a contentious issue debated by federal and state governments, health care providers, and patients. It is important for geriatric nurses to comprehend the policy and health implications of bariatric surgery for older adults. The purpose of this paper is to (a) discuss the burden of growing obesity rates on the health of older adults, (b) present the results of a literature review of bariatric surgery outcomes in older adults, and (c) evaluate the policy implications of insurance coverage of bariatric procedures.
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Esophageal rupture: A pseudo-achalasia related delayed complication after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2014; 10:e27-9. [DOI: 10.1016/j.soard.2013.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022]
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18
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Revisional laparoscopic Roux-en-Y gastric bypass following failed laparoscopic adjustable gastric banding. Obes Surg 2014; 23:947-52. [PMID: 23479088 DOI: 10.1007/s11695-013-0888-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Obesity is a worldwide epidemic and surgery is the only proven long-term treatment. The two most commonly performed bariatric procedures are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are advocates of both procedures but LAGB is associated with potentially high failure rates and may require conversion to an alternative procedure. METHODS This study reports our unit results for failed LAGB converted to LRYGB and compares them to primary LRYGB patients. All patients undergoing revisional LRYGB from July 2006 to December 2011 were included in the study. Comparisons were made to patients undergoing primary LRYGB over the same time period for post-operative weight loss, complications and length of stay. RESULTS Of the patients, 722 were analysed of which 55 underwent revisional surgery. There was no statistical difference in percentage of excess weight loss at 6 months, 1 year or 2 years following surgery between the primary and revisional surgery cohorts (54.5, 63.7, 65.2 vs 51.6, 59.5, 59.4, p = NS). There was no difference in morbidity, mortality or length of stay between the two groups. Revisional LRYGB was carried out as a single surgery in 43 (78 %) patients. CONCLUSIONS Revisional LRYGB surgery can be carried out safely and efficiently in experienced bariatric units. Good short- and medium-term weight loss can be achieved with no increase in morbidity, mortality or length of hospital stay. This study adds weight to the argument that LRYGB is the revisional procedure of choice following failed LAGB.
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Cobourn C, Chapman MA, Ali A, Amrhein J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes Surg 2014; 23:903-10. [PMID: 23446665 PMCID: PMC3671103 DOI: 10.1007/s11695-013-0881-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. METHODS Morbidly obese patients, ≥ 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time. RESULTS This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender. CONCLUSIONS Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, 1413 Hurontario St., Mississauga, Ontario, L5G 3H5, Canada.
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Pfeil M. Patients’ perception of the nursing contribution to gastric band surgery. BRITISH JOURNAL OF NURSING 2014; 23:95-9. [PMID: 24605393 DOI: 10.12968/bjon.2014.23.2.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Pfeil
- School of Nursing Sciences, University of East Anglia
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Lebovitz HE. Metabolic surgery for type 2 diabetes with BMI <35 kg/m(2) : an endocrinologist's perspective. Obes Surg 2014; 23:800-8. [PMID: 23515973 PMCID: PMC3653036 DOI: 10.1007/s11695-013-0907-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m2 justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m2. All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m2.
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Affiliation(s)
- Harold E Lebovitz
- Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA.
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22
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Living with a Gastric Band: A Qualitative Study. Healthcare (Basel) 2014; 2:47-59. [PMID: 27429259 PMCID: PMC4934493 DOI: 10.3390/healthcare2010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Gastric banding is an established and effective form of weightloss surgery. Semi-structured interviews explored the experiences of gastric banding of twenty purposively recruited patients one year after surgery. Data was analysed using thematic analysis. RESULTS Three themes emerged. They included 'Exercising choice' (restriction by the band was counterbalanced by new food-related choices.); 'Rediscovering life' (improved health, physical ability and energy enabled the patients to re-discover life.) and 'Goals achieved with no regrets' (patients had nearly achieved their self-set goals.) CONCLUSION Beyond achieving weight loss and improved health, the participants had improved quality of life as defined by patients. Knowledge about this active process informs the care of these patients.
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Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, Horlick M, Kalarchian MA, King WC, Mitchell JE, Patterson EJ, Pender JR, Pomp A, Pories WJ, Thirlby RC, Yanovski SZ, Wolfe BM. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310:2416-25. [PMID: 24189773 PMCID: PMC3955952 DOI: 10.1001/jama.2013.280928] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Severe obesity (body mass index [BMI] ≥35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements, but little is known about long-term outcomes of these operations. OBJECTIVE To report 3-year change in weight and select health parameters after common bariatric surgical procedures. DESIGN AND SETTING The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. PARTICIPANTS AND EXPOSURE: Adults undergoing first-time bariatric surgical procedures as part of routine clinical care by participating surgeons were recruited between 2006 and 2009 and followed up until September 2012. Participants completed research assessments prior to surgery and 6 months, 12 months, and then annually after surgery. MAIN OUTCOMES AND MEASURES Three years after Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), we assessed percent weight change from baseline and the percentage of participants with diabetes achieving hemoglobin A1c levels less than 6.5% or fasting plasma glucose values less than 126 mg/dL without pharmacologic therapy. Dyslipidemia and hypertension resolution at 3 years was also assessed. RESULTS At baseline, participants (N = 2458) were 18 to 78 years old, 79% were women, median BMI was 45.9 (IQR, 41.7-51.5), and median weight was 129 kg (IQR, 115-147). For their first bariatric surgical procedure, 1738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1252 (63%) dyslipidemia, and 1601 (68%) hypertension. Three years after surgery, median actual weight loss for RYGB participants was 41 kg (IQR, 31-52), corresponding to a percentage of baseline weight lost of 31.5% (IQR, 24.6%-38.4%). For LAGB participants, actual weight loss was 20 kg (IQR, 10-29), corresponding to 15.9% (IQR, 7.9%-23.0%). The majority of weight loss was evident 1 year after surgery for both procedures. Five distinct weight change trajectory groups were identified for each procedure. Among participants who had diabetes at baseline, 216 RYGB participants (67.5%) and 28 LAGB participants (28.6%) experienced partial remission at 3 years. The incidence of diabetes was 0.9% after RYGB and 3.2% after LAGB. Dyslipidemia resolved in 237 RYGB participants (61.9%) and 39 LAGB participants (27.1%); remission of hypertension occurred in 269 RYGB participants (38.2%) and 43 LAGB participants (17.4%). CONCLUSIONS AND RELEVANCE Among participants with severe obesity, there was substantial weight loss 3 years after bariatric surgery, with the majority experiencing maximum weight change during the first year. However, there was variability in the amount and trajectories of weight loss and in diabetes, blood pressure, and lipid outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Barreca M, Vasas P, Whitelaw D, Yue D, Jambulingam P, Jain V. Disappointing Long-Term Result After Laparoscopic Adjustable Gastric Band Insertion. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marco Barreca
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - Peter Vasas
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - Douglas Whitelaw
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - Dominic Yue
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - Periyathambi Jambulingam
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - Vigyan Jain
- Bariatric Surgery Unit, Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
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Brown JJS, Boyle M, Mahawar K, Balupuri S, Small PK. Laparoscopic adjustable gastric band survival in a high-volume bariatric unit. Br J Surg 2013; 100:1614-8. [DOI: 10.1002/bjs.9284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Although laparoscopic adjustable gastric bands (LAGBs) have been shown to be efficacious, their long-term usefulness has been questioned. This study examined the fate of LAGBs in a unit with over a decade of experience in their use. Patient factors related to the need for, and timing of, band removal were investigated.
Methods
A prospectively maintained database was used to identify all patients with a LAGB. Patient demographics, need for band removal and band survival were examined. Logistic regression modelling was done and Kaplan–Meier curves were calculated for band survival.
Results
Between 2000 and 2012, 674 bands were placed in 665 patients. Of these, 143 (21·2 per cent) were removed. There was no difference in rates of removal by sex (P = 0·910). The highest rates of removal were in patients aged less than 40 years (26·7 per cent), and those with a BMI greater than 60 kg/m2 (28·6 per cent). Earlier band removal was seen in younger patients (P = 0·002). Rates of removal increased linearly by earlier year of placement. Of bands placed 4 or more years previously, 35·0 per cent required removal. Eighty-three patients (58·0 per cent) who had a LAGB removed went on to have a further bariatric procedure (band to bypass, 66; band to sleeve, 17).
Conclusion
Even in experienced hands LAGB does not appear to be a definitive solution. In a large number of patients there appears to be a finite ‘band life’, with the majority of patients requiring conversion to a further bariatric procedure.
Presented in part to a meeting of the British Obesity and Metabolic Surgery Society, Glasgow, UK, January 2013, as an oral presentation for which it was awarded the council prize; published in abstract form as Br J Surg 2013; 100(Suppl 3): 2
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Affiliation(s)
- J J S Brown
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - M Boyle
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - K Mahawar
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - S Balupuri
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - P K Small
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
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Phoenix GK, Penney N, Cocker DM, Davies A, Smellie J, Bonanomi G, Thompson J, Efthimiou E. Comparison of weight loss achieved after laparoscopic adjustable gastric banding between Afro-Caribbean, Caucasian and South Asian adult female patients in a London bariatric centre. Ann R Coll Surg Engl 2013; 95:335-40. [PMID: 23838495 DOI: 10.1308/003588413x13629960045995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been shown that following laparoscopic adjustable gastric banding (LAGB) procedures, Afro-Caribbeans achieve poorer weight loss compared with Caucasians. The reasons for this are multifactorial. However, studies have been based on mainly female patients from the US and none to date have been from the UK. Furthermore, South Asians have not previously been compared. The aim of this study was to compare excess weight loss percentage (%EWL) outcomes up to five years following LAGB in Afro-Caribbean, Caucasian and South Asian females in a London-based teaching hospital. METHODS An analysis was carried out of prospectively collected data of female patients aged ≥16 years of Afro-Caribbean, Caucasian or South Asian origin who underwent LAGB between October 2000 and December 2011. Data included demographics, co-morbidities and anthropometrics. RESULTS Overall, 596 females underwent LAGB; 316 Caucasians (53.0%), 64 Afro-Caribbeans (10.8%) and 27 South Asians (4.5%) formed the majority of those who disclosed ethnicities. Age and initial body mass index (BMI) were comparable between Afro-Caribbeans and Caucasians (mean BMI: 47.3kg/m²[standard deviation [SD]: 7.5kg/m², range: 37.0-78.3kg/m²] vs 45.8kg/m²[SD: 7.1kg/m², range: 24.7-79.8kg/m²], p=0.225). A non-significant trend suggested less %EWL in Afro-Caribbeans than in Caucasians at 6 months, and at 1, 2, 3, 4 and 5 years (21.4% vs 24.4%, p=0.26; 27.4% vs 31.3%, p=0.27; 33.0% vs 36.8%, p=0.15; 39.0% vs 45.8%, p=0.14; 34.2% vs 45.3%, p=0.16; 37.1% vs 47.6%, p=0.67). South Asians and Caucasians had a similar age and preoperative BMI (mean BMI: 43.6kg/m² [range: 32.5-59.1kg/m²] vs 45.8kg/m² [range: 24.7-79.8kg/m²], p=0.08). The %EWL was greatest at three and four years among South Asians although numbers were small (n=4 and n=3 respectively). CONCLUSIONS A non-significant trend suggests poorer weight loss outcomes in Afro-Caribbeans compared with Caucasians in our cohort. Discussion of realistic weight loss outcomes as well as enhanced follow-up and dietary modifications are required for Afro-Caribbean patients. Low numbers prevent definitive conclusions regarding South Asians. Multicentre studies across England are required to better define any differences between ethnicities.
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Affiliation(s)
- G K Phoenix
- Chelsea and Westminster Hospital NHS Foundation Trust, UK
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Ayloo SM, Masrur MA, Contino G, El Zaeedi M, Giulianotti PC. Two-year follow-up of wound complications associated with laparoendoscopic single-site adjustable gastric banding. Surg Obes Relat Dis 2013; 9:696-700. [DOI: 10.1016/j.soard.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/30/2022]
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Wang X, Zheng CZ, Chang XS, Zhao X, Yin K. Laparoscopic adjustable gastric banding: a report of 228 cases. Gastroenterol Rep (Oxf) 2013; 1:144-8. [PMID: 24759820 PMCID: PMC3938002 DOI: 10.1093/gastro/got023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding (LAGB) in obese patients. Methods: This retrospective study included 228 patients (73 males and 155 females, mean age, 32.5 ± 10.3 years) who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011. The body weight and postoperative complications were followed up. Results: The pre-operative mean body mass index (BMI) was 39.5 ± 6.3 kg/m2. Except in one case of inadequate exposure of the stomach, all laparoscopic procedures were successfully accomplished, with no conversion to open surgery. The mean operation time was 65.0 ± 20.3 min. The mean hospital stay was 2.7 ± 0.9 days. Early postoperative complications (<30 days) occurred in five cases (2.2%) and late complications (>30 days) occurred in 75 cases (32.9%), including 56 cases (24.6%) with band-associated complications. The percentage of excess weight loss (EWL%) at 1, 3 and 5 years was 40.5 ± 30.5%, 59.5 ± 41.5% and 58.9 ± 46.4%, respectively. The percentages of patients with EWL% >25%, >50% and >75% were, respectively, 60%, 33% and 0% at 1 year follow-up, 43%, 39%, and 16% at 3 years follow-up and 40%, 34% and 16% at 5 years follow-up. Conclusion Although LAGB has low peri-operative mortality and morbidity rates, it is associated with a high late complication rate and unsatisfactory weight loss. It may be optional, but not the first choice, for the treatment of obesity.
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Affiliation(s)
| | | | | | | | - Kai Yin
- *Corresponding author. Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China. Tel: +02131161586; E-mail:
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Imaging Evaluation of Laparoscopic Greater Curvature Plication: Preliminary Observations. AJR Am J Roentgenol 2013; 201:W262-70. [DOI: 10.2214/ajr.12.9385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Caiazzo R, Pattou F. Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose? J Visc Surg 2013; 150:85-95. [PMID: 23623562 DOI: 10.1016/j.jviscsurg.2013.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Laparoscopic Adjustable Gastric Banding Connecting Tube Causing Small Bowel Obstruction and Perforation. Case Rep Surg 2013; 2013:296037. [PMID: 24368962 PMCID: PMC3867925 DOI: 10.1155/2013/296037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/25/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Laparoscopic adjustable gastric banding (LAGB) is an effective method of reducing excess weight in obese patients. We report a patient who developed a bowel obstruction caused by the connecting tube between the gastric band and the injection port. Case Presentation. The patient was a 42-year-old Caucasian female who had undergone LAGB 19 months earlier. She presented with dehydration, low-grade fever, tachycardia, and mild abdominal tenderness. Laparotomy revealed that the connecting tube was looped around the mesentery, and a loop of small bowel was incarcerated between the tube and the mesentery. The incarcerated small bowel loop was perforated in two places. Conclusion. Surgeons should be aware of the possibility of obstruction caused by the connecting tube in patients who have undergone LAGB.
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Kim JH, Wolfe B. Bariatric/Metabolic Surgery: Short- and Long-Term Safety. Curr Atheroscler Rep 2012; 14:597-605. [DOI: 10.1007/s11883-012-0287-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
PURPOSE OF REVIEW Bariatric surgery is an important option for the treatment of severe (type III) obesity. Its role in the management of type 2 diabetes in overweight and obese patients needs to be defined. RECENT FINDINGS Intensified medical therapy can achieve target metabolic goals in many but not all patients with type 2 diabetes. Bariatric surgery can normalize or improve glycemia in severely obese patients with type 2 diabetes. The complications of bariatric surgery are significant and include operative mortality, early and late surgical complications and late nutritional deficiencies. Comparative studies of bariatric surgery versus intensive medical therapy in the management and clinical outcomes of patients with type 2 diabetes are needed to evaluate relative risk/benefit of each. Bariatric surgery studies in type 2 diabetes are lacking long-term follow-up metabolic and clinical outcomes data. SUMMARY Current data are insufficient to recommend bariatric surgery as a primary treatment for type 2 diabetes. However, it can be recommended for patients whose target metabolic control cannot be achieved by intensive glycemic control because of intolerance or inadequate responses to nutritional and pharmacologic treatments.
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Affiliation(s)
- Harold E Lebovitz
- State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
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